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The Lindsay Clancy murder trial has captured national attention. When a mother in suburban Duxbury, Massachusetts, seemingly picture-perfect with three young children, strangles her three children (ages 8 months, 3, and 5), the question arises: Could this happen to anyone, anywhere?

As a reproductive psychiatrist with over two decades of experience, I have treated more than a thousand women with postpartum depression and anxiety, and fewer than twenty with postpartum psychosis. The condition is rare, occurring in 1–2 per 1,000 postpartum women, but devastating. Postpartum psychosis typically presents with fluctuating symptoms: mood disturbance (depression, elevated or irritable mood), psychotic features (delusions, hallucinations, illogical thoughts), and sometimes bizarre behavior. In most cases, it represents a bipolar-spectrum mood disorder rather than a primary psychotic illness.

The Challenge of Recognition

In my clinical practice, I have encountered subtle presentations of postpartum psychosis. Women may appear sad, depressed, anxious, or agitated, often with severe sleep disturbance. When sleep deprivation persists and antidepressants fail to help, symptoms can worsen. In a subset of women with underlying postpartum psychosis, antidepressants may actually exacerbate the presentation, triggering irritability, agitation, and worsening insomnia.

Patients frequently use socially acceptable language: "I’m so anxious," "I’m exhausted." They rarely volunteer paranoid ideation or auditory hallucinations. Intrusive thoughts about wanting to die, or distressing images of harm to the baby, can occur in both........

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